What is the prescription for scabies treatment?

Scabies Treatment Prescription

The first-line treatment for scabies is permethrin 5% cream applied from head to toe (including scalp, hairline, neck, temple, and forehead), left on for 8-14 hours, then washed off. 1, 2

Detailed Treatment Protocol

Permethrin 5% Cream (First-Line Treatment)

• Application method: Thoroughly massage into the skin from head to soles of feet
• Coverage areas:
  • Adults: Entire body including hairline, neck, temple, and forehead
  • Infants and geriatric patients: Include scalp in application
• Quantity: Approximately 30 grams for an average adult
• Duration: Leave on for 8-14 hours, then wash off (shower or bath)
• Frequency: One application is generally curative 2
• Retreatment: Repeat application after 7-10 days to kill newly hatched mites 1

Special Considerations

For Different Populations:

• Pregnant or lactating women: Permethrin 5% cream is preferred over oral ivermectin 1
• Infants and young children: Permethrin 5% cream (include scalp in application) 1, 3
• Adults with treatment failure: Consider scalp-to-toes application, as head involvement may be present even in adults 3

Treatment Failures:

If permethrin treatment fails, consider oral ivermectin:

• Dosage: 200 μg/kg body weight as a single dose
• Timing: Repeat after 1-2 weeks
• Weight requirement: Recommended for individuals ≥15 kg 1
• Administration: Take with food to increase bioavailability 1

Important Clinical Pearls

• Persistent itching: May continue for several weeks after successful treatment and is rarely a sign of treatment failure 1, 2
• Treatment failure indicators: Demonstrable living mites after 14 days require retreatment 2
• Environmental measures:
  • Machine wash and dry all bedding and clothing using hot cycle
  • Items that cannot be washed should be removed from body contact for at least 72 hours 1
• Household management: All household members and close contacts should be treated simultaneously, even if asymptomatic 1

Common Pitfalls to Avoid

1. Inadequate application area: Failure to apply permethrin to the entire body including head regions (especially in infants and elderly) can lead to treatment failure 3
2. Single application only: While the drug label states one application is generally curative 2, guidelines recommend repeating treatment after 7-10 days to ensure complete eradication 1, 4
3. Retreating too soon for persistent itching: Itching often persists for weeks after successful treatment and is not necessarily an indication for retreatment 1, 2
4. Neglecting to treat contacts: Failing to simultaneously treat all household members and close contacts can lead to reinfestation 1

For severe or crusted scabies cases, a combination of oral ivermectin and permethrin 5% cream may be considered, with antibiotics if secondary bacterial infection is present 1.